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Depression and HIV/AIDS Treatment Nonadherence: A Review and Meta-analysis

Gonzalez, Jeffrey S PhD; Batchelder, Abigail W MPH, MA; Psaros, Christina PhD; Safren, Steven A PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 October 2011 - Volume 58 - Issue 2 - pp 181-187
doi: 10.1097/QAI.0B013E31822D490A
Critical Review: Clinical Science

We meta-analyzed the relationship between depression and HIV medication nonadherence to calculate the overall effect size and examine potential moderators. Overall, across 95 independent samples, depression was significantly (P < 0.0001) associated with nonadherence (r = 0.19; 95% confidence interval = 0.14 to 0.25). Studies evaluating medication adherence via interview found significantly larger effects than those using self-administered questionnaires. Studies measuring adherence along a continuum found significantly stronger effects than studies comparing dichotomies. Effect size was not significantly related to other aspects of adherence or depression measurement, assessment interval (ie, cross-sectional vs. longitudinal), sex, IV drug use, sexual orientation, or study location. The relationship between depression and HIV treatment nonadherence is consistent across samples and over time, is not limited to those with clinical depression, and is not inflated by self-report bias. Our results suggest that interventions aimed at reducing depressive symptom severity, even at subclinical levels, should be a behavioral research priority.

From the *Ferkauf Graduate School of Psychology, Departments of Medicine and Epidemiology & Population Health, Yeshiva University, Bronx, NY; †Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY; ‡Behavioral Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA; and §Behavioral Medicine, Department of Pscyhiatry, Harvard Medical School, Boston, MA.

Received for publication March 23, 2011; accepted July 11, 2011.

Funding for investigator time was supported by grants DA018603 and MH084757 awarded to Dr S.A.S. Dr J.S.G. is supported in part by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), DK 020541.

Preliminary findings were presented at the 5th International Conference on HIV Treatment Adherence, May 23-24, 2010, Miami, FL.

The authors have no conflicts of interest to disclose.

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Correspondence to: Jeffrey S. Gonzalez, PhD, Assistant Professor, Ferkauf Graduate School of Psychology, Albert Einstein College of Medicine and Yeshiva University, 1300 Morris Park Avenue, Rousso Building, Bronx, NY 10461 (e-mail:

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